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24.3.1 Treatment Approvals
All requests for footwear must be accompanied by a current recommendation from a podiatrist registered to prescribe footwear and a referral from the treating doctor.
Footwear will only be approved for conditions for which the clients has accepted liability and only where depth, custom made or specific footwear is necessary to accommodate a physical deformity.
Depth footwear may be prescribed for some corrective insoles or to accommodate forefoot abnormalities such as bunions, hammer toes, swelling etc.
Custom footwear is only prescribed for more complex problems such as severe physical deformities, arthritic changes or diabetic ulcerations. Custom footwear is a made to measure shoe provided by suppliers experienced in the manufacture of these shoes.
Requests for good walking shoes, boots or running shoes will NOT normally be considered. However, where the podiatrist recommends a specific type of shoe that is available “off the shelf” and the podiatrist is of the opinion that but for that particular shoe being available the claimant would need depth or custom footwear it should be considered. The podiatrist should be asked for reasons as to why this particular footwear mets the needs associated with the accepted condition. Delegates need to ensure that these requirements are met before meeting or reimbursing for the cost of the footwear. Specific footwear will generally be cheaper than either of the other options.
One pair of recommended footwear will be supplied initially. This may be reviewed at the discretion of the Delegate under appropriate professional advice. This may include corrective work boots if the client is currently employed. Replacement is not time based, but as required. The prescribing podiatrist will need to view the existing footwear to decide whether it can be altered, repaired or whether it needs to be replaced. On average, depth and custom footwear would be expected to last 2–3 years and specific footwear 1-2 years.
When requests for treatment are denied this is a reviewable decision under S62 of the SRCA. The determination must be in writing to the claimant and must include reasons for the decision as well as a statement that the determination can be reconsidered if the employee or claimant is dissatisfied with the determination. If appropriate the medical provider supplying the footwear that we are not paying for also need to be advised. If a Departmental medical advisor has been asked to comment on the case and recommends that the request be declined their written comments are to be placed on the client's E-file and paper file reflecting that recommendation. A note in Defcare should also be made.
RCG Medical Treatment